News in brief
Wachter report overview and Jeremy Hunt’s response: The NHS in England needs time, money and a skilled and supported workforce to realise the benefits of digital health, according to the long-awaited Wachter review. The report’s advisory group, which focussed on the secondary care sector, recommended a staged approach to digitisation for NHS trusts from 2016 to 2019 and 2020 to 2023, with priority given to the most advanced NHS trusts. Central funds should be matched with local funding, it recommended, and linked to implementation plans. The review also called for the appointment of a national chief clinical information officer (CCIO) (Keith McNeil has already been appointed the first CCIO for the NHS in July 2016), investment in the digital workforce and more trained clinician-informaticists, greater interoperability and evaluation, and sharing of good practice through local and regional learning networks. The Health Service Journal (subscription required) noted that Wachter had called on the government to ditch its 2020 target for a paperless NHS. DigitalHealth.net reported that the review, and Wachter’s subsequent speech at NHS Expo, said that half of NHS trusts should not get any money for digitisation until after 2020, as they were not as digitally mature as other trusts. In response, health secretary Jeremy Hunt welcomed the report, and announced the selection of the 12 centres of excellence sites to drive digital NHS services and benefit from central support, reported National Health Executive. Updates on a new 111 service, that will allow diagnosis for patients via their smartphone by the end of next year, were also noted by The Telegraph, alongside the announcement of the new NHS.uk website that will allow patients to book appointments, access medical records and order prescriptions, the BBC reported.
Junior doctors September strike suspended as BMA give Jeremy Hunt four-week ultimatum: The British Medical Association (BMA) has announced it is suspending industrial action planned for the week of 12th September 2016, reported The Huffington Post. A spokesperson for the union said: “The remaining programme of industrial action stays in place.” Junior doctors had been planning a five-day walkout from 12-16 September. But while the first strike is suspended, further action in the run up to Christmas remains scheduled. A statement from Ellen McCourt, the BMA’s new junior doctor committee chair, read: “Patient safety remains doctors’ primary concern. For the first time in this dispute NHS England have told us that a service under such pressure cannot cope with the notice period for industrial action given. Our hospitals are chronically under staffed. Our NHS is desperately underfunded. We have to listen to our colleagues when they tell us that they need more time to keep patients safe. The BMA is therefore suspending the industrial action planned for the week of 12th September. The remaining programme of industrial action stays in place. There are four weeks until October. The secretary of state must use this time to listen and act.” A Department for Health spokesperson said: “As doctors’ representatives, the BMA should be putting patients first not playing politics in a way that will be immensely damaging for vulnerable patients. What’s more, the BMA must be the first union in history to call for strike action against a deal they themselves negotiated and said was a good one. Whilst there are many pressures on the frontline, funding is at record levels, with the highest number of doctors employed in the history of the NHS. Co-operation not confrontation is the way forward to make sure patients get the best treatment and the NHS is there for people whenever they need it.”
One in four CCGs predict 2016-17 deficit as NHS demand soars: One in four clinical commissioning groups (CCG) and nearly half of NHS trusts predict they will end the current financial year in deficit, according to a report from The King’s Fund on the extent of the funding crisis facing the health service, reported GPOnline. A total of 23% of CCGs and 47% of NHS trusts said they expected to end 2016-17 in deficit and the proportion of CCGs predicting a deficit has doubled since this time last year. Meanwhile, key NHS performance targets are now being missed, not just in winter, but all year round as demand facing the health service hits unprecedented levels. The number of patients attending A&E departments in the first quarter of 2016-17 hit 6 million, with 1 million of these admitted to hospital. Nearly one in 10 patients spent more than four hours in A&E, the highest proportion since 2003-4. The King’s Fund policy director Richard Murray said: “While new investment and actions taken to tackle overspending have reduced deficits among NHS providers in the first quarter of the year, it would be a mistake to suggest that the financial pressures which have engulfed the NHS have eased. Unless more is done to tackle rising demand, the ideas emerging from sustainability and transformation plans about cutting beds and reconfiguring hospitals will look even more unrealistic.” BMA chairman Dr Mark Porter said: “Up and down the country, hospitals are being forced to close their doors, or limit access to vital services like paediatrics and emergency care due to chronic understaffing. The government appears to have no real solution to the funding crisis engulfing the NHS.” A Department of Health spokesman said: “We are committed to delivering a safer seven day NHS which is why we have invested £10bn to fund the NHS’s own plan to transform services in the future.”
NHS bed blocking at monthly worst level on record: The number of days lost through so-called “bed blocking” in England is at its highest monthly level on record, new figures have shown, reported The Telegraph. Patients taking up beds when they no longer required hospital care took up 184,188 days in July compared to the 147,376 days in the same period last year, according to NHS England data. The figure, the highest since records began in 2010, marks a rise from the 171,298 days lost through bed blocking in June. The number of patients delayed at midnight on the last Thursday of July – used to provide a snapshot of levels of bed blocking – is also at a record high, the figures show. There were 6,364 patients taking up beds at this point, the highest monthly figure since the data was first collected in August 2010. Clare Marx, president of the Royal College of Surgeons, said bed capacity was a “major concern” and warned that the NHS would “remain in a state of constant winter” unless funding issues were addressed. She said: “Patients’ treatment is too often delayed because there is no space on wards for them after their operations. Unless the NHS and social care does more to help patients leave hospital sooner and the elective bed capacity increases, I fear we will not see waiting times improve. The forthcoming Autumn Statement offers an opportunity for the government to provide more money for the NHS and social care, and to agree to a cross-party commission to review how we can make the NHS sustainable for the long term. Without a serious look at what the NHS needs in funding, we will remain in a state of constant winter.”
Health professionals demand investment as youngsters forced to wait months for mental health treatment in Scotland: A major overhaul of mental health support for children in Scotland is needed after stark new figures revealed young people enduring more than a year for treatment, health professionals have said, reported The Courier.co.uk. Nationally, the number of children and young people waiting more than a year for specialist help with mental health problems has almost trebled. Of those starting treatment in the period April and June 2016, 147 had been on a waiting list for more than 12 months, up from 52 in the previous quarter. The Scottish Children’s Services Coalition (SCSC), which is made up of service providers for children and young people, has called for urgent action to boost funding and “radically improve” the service. A SCSC spokesman said: “The consequent delay in diagnosis and appropriate support can lead to a crisis situation for the child or young person concerned, as well as for their family, and the need for costly extra resources to address this.” The Scottish government has demanded 90% of those referred to Child and Adolescent Mental Health Services (CAMHS) are seen within 18 weeks. Fife is shy of the target at 87.7% and two young people registered in the second quarter of this year had to wait at least 12 months for treatment. But Tayside’s remarkable turnaround has been cemented by posting a 99.6% success rate. Mental health minister Maureen Watt, who is overseeing a new mental health strategy, said they have reacted to demand increases by doubling the number of psychologists working in CAMHS and are investing an additional £150m over five years. “I have been clear with boards that any falls in performance towards the challenging 90% target, or children experiencing long waits, is simply not good enough.”
Trusts told to “ensure sufficient focus” on cost recovery from overseas visitors: The NHS will recover £500m a year by 2017-18 from overseas visitors who use its services, NHS Improvement (NHSI) and the Department of Health have promised, advising trusts to “ensure sufficient focus” is placed on cost recovery. National Health Executive reported that in a joint letter to NHS trusts, Sir Keith Pearson, independent advisor to the visitor and migrant NHS Cost Recovery Programme, and Robert Alexander, executive director of resources and deputy CEO at NHSI, laid out a number of measures designed to support the programme. An enhancement to the Summary Care Record application has been made which will mean that a banner will be displayed on patients’ NHS Spine records indicating whether their chargeable status has been established. Patients who are chargeable will have that indicated if they have paid the immigration health surcharge or an overseas visitor manager (OVM) has investigated their chargeable status and updated their notes. The enhancement is intended to make it easier for OVMs to identify chargeable patients and for additional data to be captured, while making it harder for chargeable patients to move on from one trust to the next. This particularly applies to trusts in high migrations or tourism areas and near universities with high numbers of overseas students. The two organisations also said they have launched new e-learning modules about the changing rules, aimed at finance leaders, and re-launched the Cost Recovery Support Team, which will soon be available to trusts to help them enhance their cost recovery processes.
Trust bailouts reach almost £2bn: More than half of acute trusts received some form of cash bailout in 2015-16 as total “revenue support” from the Department of Health (DH) reached almost £2bn, reported Health Service Journal (subscription required). This compares to payments totalling around £1.2bn in 2014-15, when around a third of the acute sector received a revenue bailout. The DH payments were necessary to maintain the day to day running of hospitals, in many cases to prevent them running out of cash to pay staff or creditors. Nineteen trusts received DH support worth more than 10% of their annual income. North Cumbria University Hospitals NHS Trust received loans worth 30% of its income, while Barts Health NHS Trust received the largest amount in cash terms, totalling about £130m. The vast bulk of the payments now take the form of working capital loans, carrying interest rates of up to 3.5%, which the DH expects to be repaid in full within five years. A spokeswoman for London North West Healthcare NHS Trust said its support payments were required to fund its £77m deficit, adding: “There is no realistic prospect of the trust paying back the money by 2021 without further revenue support.” University Hospitals of Morecambe Bay NHS Foundation Trust said it is talking to regulators about its “future funding requirements”, while Princess Alexandra Hospital NHS Trust said repayment would depend on the ongoing work to “develop sustainable financial and transformation plans” for the area. Roy Jackson, director of finance at Hinchingbrooke Health Care NHS Trust, said: “It is the expectation of the trust’s forward financial planning that we will return to surplus by 2021-22 and we will be in a position by that point to address historical financial support to the trust.”
NHS Digital to expand cyber security service: NHS Digital is launching three cyber security services, which will be rolled out to NHS health and care organisations, reported Computer Weekly. The services have been created by the organisation’s cyber security arm, CareCert, which launched in 2015. The programme aims to enhance cyber resilience across health and social care by providing incident broadcasts, training and resources to health and care providers. One of the services is an e-learning portal called CareCert Knowledge, which will aim to help health and care organisations train staff in “cyber security basics”. NHS Digital is also launching CareCert Assure, which is designed to help organisations assess their cyber security measures against the standards set by industry. It will also provide recommendations on how to improve data security. The third service to launch is CareCert React, which will function as a support service, providing professional guidance on actions to reduce the effect of data security incidents and restore security as soon as possible. Commenting on the launch of the services, NHS Digital chief executive Andy Williams said they were designed to improve digital security across health and care organisations and their staff. “Good digital security is key to all roles in health and care, and we want to give NHS organisations the benefit of our expertise in this area so that we can promote best practice across the sector,” he said.
National Information Board sets out programme of work: The annual report of the National Information Board (NIB) has set out 33 programmes of work to help digitise the NHS, stressing that public trust is crucial for success, reported National Health Executive. The NIB, set up in 2014, is a collaborative partnership of representatives from 29 organisations and aims to monitor the “big picture” of information and technology across the NHS. Following the government’s 2015 spending review commitment to putting £4.2bn into digitising the health service, the NIB has now chosen 33 programmes to focus on. These are grouped into 10 delivery domains, which the report said were decided on at a series of workshops in early 2016, and will be monitored by the NIB. These are: self-care and prevention; urgent and emergency care; transforming general practice; integrated care; digital medicines; paper-free at the point of care; data outcomes for research and oversight; elective care; public trust and security; infrastructure.
Health and care coalition to lobby for EU workers to remain in UK: A coalition of 29 health and social care organisations has been formed with the aim of lobbying the government to guarantee the status of EU nationals working in the sector following the Brexit vote, reported Public Finance. In a statement, the ‘Cavendish Coalition’ also pledged to provide officials leading the negotiations with expertise, evidence and knowledge on issues affecting the health and social care sectors. More broadly, the organisation seeks to ensure a sustainable workforce supply to maintain standards of care as Britain withdraws from the EU. The coalition is “united in its belief that EU citizens working in the UK’s social care and health sectors should remain”. The group has already submitted evidence to a cross-party enquiry chaired by MP Gisela Stuart, which will examine the options for guaranteeing the status of EU nationals already in the UK. Beyond this, the group aims to support the economic and social health of communities through training and employment to ensure the UK continues to be able to attract skills from Europe and around the world. Danny Mortimer, chief executive of NHS Employers, said the coalition would be a shared voice, “working together to ensure continuing quality in health and social care post-EU referendum”. He said it would provide a “focal point for engagement” with government departments, NHS arms-length bodies and regulators on the workforce issues arising from the Brexit vote. “EU citizens are a hugely valued and appreciated part of the workforce caring for service users and patients and should be treated as such,” he added.
Underutilised clinical pharmacy should be a key part of seven day NHS: Pharmacy services in acute hospitals should be used to greater effect to deliver the seven day NHS, and efforts should be made to address underutilised services, according to a new NHS England report. National Health Executive reported that the “Transformation of seven day clinical pharmacy services in acute hospitals” document found that to deliver the government’s goal of a seven day NHS by 2020, pharmacists should be available to discuss medication with patients, embed medicine optimisation in routine practice, and help address staffing shortages. However, it said that a seven day pharmacy service faces a number of challenges, including a lack of investment and shortages of worker skills and digital maturity. Keith Ridge, the chief pharmaceutical officer, said: “This report acknowledges that at various times some hospitals are under utilising the expertise available from clinical pharmacy services. Whilst there is no uniform approach for all hospitals, it is vital that expertise on medicines are available to all patients in hospital in a timely manner seven days a week to improve patient experience, safety and clinical efficiency.” The report said that NHS England and NHS Improvement should establish a Clinical Pharmacy Reference Group as part of plans to deliver the seven day NHS. It also said that NHS Improvement and the chief pharmaceutical officer for England should ensure all hospital pharmacy transformation programme plans, which are due to be submitted in April 2017, include robust plans on how they propose to implement seven day clinical pharmacy services.
EPRs top of roadmap wish list: A review by DigitalHealth.net of local digital roadmaps (LDRs) has shown many NHS organisations are prioritising core IT systems for acute trusts, many of which come with a big price tag. The survey of 17 LDRs uncovered by searching trust and footprint websites that new electronic patient record (EPR) systems top the wish lists in many draft roadmaps. Other common requirements include information sharing mechanisms, patient access to records and shared information governance. In its roadmap, NHS Wakefield Clinical Commissioning Group said that an EPR that interoperates with systems in and beyond Mid Yorkshire Hospitals NHS Trust is critical to its goals. Their roadmap said: “Without this step it will be difficult to make significant change in the district.” Merseyside’s roadmap puts a big focus on EPRs, saying that it has become a “strategic aim to have a common EPR for all adult services, seamlessly linked with children’s acute services, community based services and social care”. The region intends to agree plans to deploy a single hospital EPR spanning multiple hospital providers by winter this year. Hampshire and the Isle of Wight’s roadmap reveals the area needs £20m to support the replacement of an ageing EPR system at one of its acute trusts, and a further £10m to replace a platform at another. The focus on implementing EPRs and other core systems, such as e-prescribing systems, underlines the major gaps in healthcare IT left by the end of the National Programme for IT in the NHS; and the likely importance of central funding to getting these in place. DigitalHealth.net also reported that many roadmap footprints were relying on central funding pots to support their goals, pots that footprints have already been warned are severely financial constrained.
Technology ‘must be embedded in STPs’ and IT moved away from separate silos: Embedding technology to transform the NHS is not an optional extra, which is why it is a central part of the sustainability and transformation plans (STPs), Matthew Swindells, national director for operations and information at NHS England, has said, reported National Health Executive. Speaking at NHS Expo, he stated that the NHS faces significant challenges as there is huge variation in digital maturity. “We’ve created the STPs to be the vehicle of that change, to be able to drive that locally and not create a number of top-down changes that is the same everywhere, because it is clear the NHS isn’t the same everywhere. Salford is not the same as Devon or Ipswich. We need to create a bottom-up approach doing the things that need to be done, and not ducking the hard stuff,” said Swindells. He added that a big part of the STP work, which has come under fire recently for various proposals, including hospital closures, has been about “bringing the brightest minds together to solve the hardest problems”. Swindells said: “It is about evolving a new set of models of care where STPs are thinking about whole systems, and taking whole-system design across health and social care – creating a vision for the next four years and then delivering that into contract. So we go from a vision into something that is executable and we implement with skill, panache and consultation and in a way that we do the changes that we’ve talked about. But we can’t do that if we work in silos.”
Cheshire shares records across 80 organisations: Cheshire has gone live with a shared care record that covers acute, primary, council, community, mental health and cancer data across the region using Graphnet’s CareCentric, reported DigitalHealth.net. More than 80 health and care organisations are participating in the Cheshire Care Record, with 44m clinical records available over the system. There are now operational feeds from two Cheshire councils, acute, specialist, mental health, and community NHS trusts along with four clinical commissioning groups (CCG), covering 739,000 people. Jackie Miller, project manager for Cheshire Care Record, said: “It has been a significant undertaking, but it does demonstrate a great partnership working across Cheshire. I think we have achieved the most of any shared care record in the country, in that I think we are the only shared care record that has the breadth of data covering social, primary, community, acute and cancer care.” Each participating partner provides a data feed into CareCentric, and then authorised staff can access a read-only record. There is GP data from 79 GP practices, with 11 still to participate. Markus Bolton, a director at Graphnet, said: “They are politically very difficult to put together these projects, and where they should really get their pat on the back is for getting so many organisations to contribute their data.” Bolton said that since the “mega roll-out” in June, users have been growing by about 6% a week with an expected 2,000 users by the end of the year. Earlier this year, 17 health and social care organisations in Berkshire began sharing care records using the CareCentric software. Last year Graphnet was used to build share care record in Sutton, to exchange information between the local council and CCG, and in Manchester between three CCGs and the city council.
Government picks EMC for 100,000 Genomes Project data storage: The 100,000 Genomes Project, which is being carried out by the Department of Health body Genomics England, aims to sequence and collect the complete DNA sequences of 70,000 NHS cancer and rare disease patients, and their families, reported PublicTechnology.net. The aim is to analyse these genetic sequences – which will be de-identified – to help develop new disease diagnostics and create personalised treatments, as well as to encourage innovation in the UK’s bioscience sector. The sequencing of a single genome creates hundreds of gigabytes that need to be stored digitally. The project, which has sequenced 13,040 genomes to date, is expected to generate 10 times more data in the next two years. Genomics England already uses EMC Isilon for the storage of its sequence library, and has today announced it will use an Isilon data lake to store all the data collected during the sequencing process securely for it to be analysed. “There are few better examples of the fundamental impact that analysis of data sets can have on society,” said Ross Fraser, the vice-president and managing director of UK and Ireland at EMC. He added: “Delivering the platform for this large scale analytics in a hybrid cloud model will help accelerate the impact big data analytics could have on the NHS, potentially delivering billions in efficiencies in care delivery and improving patient outcomes immeasurably.” According to a statement from EMC, the data lake will initially allow 17 petabytes of data to be stored and used in analysis.
Diabetes management to be improved by data from health apps fed into NHS records: Health secretary Jeremy Hunt has announced that consent-based data from mobile health apps and wearable activity trackers such as Fitbits will feed directly into people’s personal health records, reported Diabetes.co.uk. Hunt said that users will soon be able to securely share their own personal health data from a new list of NHS-approved apps and other technology collected by mobile devices and linked directly into patients’ records. Hunt introduced his health software plan as part of a series of measures to help put patients proactively in control of their healthcare destiny. The hope is that by combining device-based findings with medical records, health software could be able to offer doctors a more complete medical profile for users, facilitating feedback and disease management. This came after a recent Care Quality Commission (CQC) review on diabetes care in England revealed that the NHS must do more to help people with diabetes self-manage their condition as the challenge posed by the disease is “enormous”. The extent to which people are supported to successfully self-manage their disease appeared limited until now. The CQC review highlighted some great examples of community diabetes care but everyone who lives with diabetes often can’t access the right level of personalised care. What is going to change with apps is the way that they link directly into medical records, which holds promise to help all parts of the healthcare system make self-care a real priority for the benefit of patients and the future of the NHS.
Harrow and IBM partner to build up health and social care technology: Harrow Council has entered into a partnership with IBM to scale-up a prototype system developed in-house for better managing personalised social care services between users, caregivers and authorities as part of a ten-year agreement that aims to make use of cognitive technologies. Government Computing reported that by teaming up with IBM Watson Health, the authority said it hoped to expand its My Community e-Purse (MCeP) system beyond its 1,000 present users as a means of cutting costs and improving efficiency in administering social care. The deal was claimed to be the first of its kind for a local government organisation in the UK. The prototype allows health and social care providers to bid on supplying services as part of plans to ensure more competitive contracts, with IBM’s Watson Care Manager technology intended to automate payments and ensure users are receiving the service as required. The platform maximises the workflow for care management activities such as scheduling, managing budgets, selecting providers and enabling care. IBM is expected to use Harrow’s technology as the basis for new technology that will implement the company’s artificial intelligence and user interface experience to potentially serve a wider number of authorities and organisations going forward based around its Watson Care Manager solution. “Using Harrow Council’s expertise and innovations in adult social care, IBM will enhance Watson Care Manager to enable individuals and caregivers to quickly and easily select the most appropriate provider that can deliver the services they need, using their allocated personal budget,” said the authority in a statement. “Harrow have consistently taken an innovative approach to delivering services, which makes Watson Care Manager a natural fit in advancing greater personalisation and data-driven efficiency,” said Martin Duggan, IBM director of social programmes.
Wolverhampton patients to benefit from data project success: The Royal Wolverhampton NHS Trust (RWT) has completed a successful data migration and archive project to centralise patient demographic and scheduling information, helping to deliver more coordinated and efficient patient care, reported DigitalHealth Age. Aided by Stalis, the project included safely and securely transferring patient data from the trust’s community services IT system to its central patient administration system (PAS). The trust will be able to build and expand the use of its clinical web portal to consolidate and standardise working practices across the organisation that will support the delivery of clinical information to frontline staff. RWT used Stalis’ CareXML platform to match and merge over 109,000 master patient index (MPI) records that include essential patient demographic information such as name, gender, date of birth, and contact information. More than 20,000 records and around 5,000 new registrations were created for patients which were not already in the PAS. Around 140,000 referrals as well as other clinical activity data were transferred across. Nick Bruce, associate director of ICT at RWT, said: “It’s critical that patient information is accurate and up-to-date to support hospital processes such as sending appointment letters to patients or notifying their GPs on progress with their care.” This was a key measure of the latest Dame Fiona Caldicott report, which recognised that technology could help protect patient data.
Taunton and Somerset FT named as global digital exemplar by government: Taunton and Somerset NHS Foundation Trust is one of 12 trusts that has been named by the government as a global digital exemplar in the NHS, reported eHealthNews.eu. The trust will receive up to £10m of funding over the next two years to pioneer digital excellence and share best practice. Recognised for its digital maturity and innovative digital health initiatives, the trust, which runs Musgrove Park Hospital, will be given the financial backing and support to fast track its plans to become world class in its digital deployments; using technology to help staff achieve higher efficiencies, enable better organisational workflows and deliver better patient care. This includes ensuring that all systems across Somerset are interfaced, so that clinicians and healthcare professionals across the community have information and data at their fingertips. Patients will also be able to view and add to their patient record, seeing hospital test results, for example, at the touch of a button. Dr Sam Barrell, chief executive at the trust, said: “We are thrilled to have been chosen, as it means we can really press ahead with bringing our NHS technology into the digital age. This work is ultimately about improving patient care and improving the patient experience, making healthcare as accessible as everything else that people do online in their everyday lives.” Less than 12 months ago the trust deployed openMAXIMS, an open source electronic patient record system in A&E, theatres, outpatients, and the hospital’s 30 wards. It was the trust’s first step in a much bigger programme to become paper-light by 2018 and deliver a fully interoperable digital healthcare community in Somerset.
NHS Confederation sets out busy schedule for the three main political conferences: Members of the NHS Confederation’s senior team will be attending the three main political conferences to represent, voice and share the experiences and concerns of health and care leaders across the country. At the Liberal Democrat Party Conference in Brighton, the Labour Party Conference in Liverpool, and the Conservative Party Conference in Birmingham, discussion will take place on whether national plans will deliver local requirements, with other sessions on patient expectations and community solutions for hospital pressures.
Opinion
NHS finances: a game of two halves
Richard Murray, director of policy at The King’s Fund, takes a look at how NHS commissioners and providers are coping on the current financial pressures.
“It’s a game of two halves. First, the good news. The arrival of the £1.8bn Sustainability and Transformation Fund alongside a suite of other financial control measures has led to the provider deficit being reduced from £930m in the first quarter of last year to £461m for the same period this year.
“So where is the bad news? First providers were behind on their cost improvement plans by £45m overall – in other words, their better than expected finances were not driven by better performance on efficiency and savings, quite the opposite in fact. Second it was worrying to see spending on waiting list initiatives and the outsourcing of clinical work rising to £115m. Third, there are still 24 providers who have rejected the financial targets (aka control totals) that NHS Improvement has set for them. In addition, another 29 failed to meet their finance and/or performance targets in the first quarter and so had their sustainability and transformation funding withheld.
“Taking these three things together, this may explain why, despite rather better quarter one performance, providers as a whole actually raised their forecast year-end deficit to £644m and our survey found that only a third of trust finance directors were confident they would meet their control total at the end of the year.
“In 2016/17 commissioners saw a sharp increase in the savings they were required to make, from the £1.9bn savings actually delivered last year to a planned £3.1bn this year. In quarter one last year, less than 10% of CCG finance leads described themselves as `very concerned’ over their required efficiency savings target, whereas now it is just under 50%, and confidence has declined since the start of the financial year.
“Worries over the sustainability of both provider and commissioner efficiency savings would on their own be a warning sign. Put alongside seemingly relentless increases in demand and the evidence that the NHS is reaching its limits on capacity this could make for a very difficult winter for the NHS.”
Empowering laboratories of the future: the urgent need for clinical context
Laboratory professionals must be given detailed clinical information to make decisions on the most effective testing for patients, as we can no longer afford for laboratories to be confined to the back office, writes InterSystems’ Martin Wilkinson.
In an article for Pathology in Practice, Wilkinson, the company’s director of product introduction, strategy and user adoption, writes: “Laboratories across the world still work largely in isolation to clinical providers. Even today, in the digital age of sharing information, a large majority of laboratory professionals are not given the full clinical perspective on the very patients they are carrying out tests for, which is something that must change with urgency.
“Diagnostic functions working within and alongside our health services need to be given clinical context and access to wider sets of information, so that laboratory professionals can make active and effective decisions on testing, and not just rely on inadequate and even sketchy requests from clinical colleagues in different care settings.
“It is time to move the laboratory out of the back office, to become a core element of clinical delivery.”
I’m a better doctor for accepting that I have a mental health problem
Dr Zoe Norris gives a very open and honest account of her mental struggles as an overworked GP, in the Guardian Healthcare Network.
“I didn’t realise I had a mental health problem. I’m a GP and it’s a common misconception that we don’t get them. We get stressed, of course. We get burnout – yes. But we don’t get mental health problems.
“When I found myself working in a practice hit, like so many others, by the lack of GPs and nurses of course it was difficult. Spending days as the only doctor for 8,500 patients was horrific. On-call days started early with visits that were left over from earlier in the week because we hadn’t had enough doctors to go out. There was a list of patients to call back before the phone lines even opened, booked in by the receptionists because they had nowhere else to put them. Blood results to look at. Medication queries to answer. Letters to read and file. Repeat prescriptions to sign. Complaints letters to respond to. Care Quality Commission boxes to tick.
“It was never ending. Somehow, in the middle of all this, I was expected to try and make a quiet calm, caring bubble with each patient for ten minutes. I was meant to put all this out of my mind and focus only on them. It’s what they deserved and it’s what I wanted to do. But I couldn’t.
“I ignored all the signs – sleepless nights, early morning waking, overeating, drinking too much, no enjoyment in anything, dreading the next day. I ignored that I was burnt out. I ignored that I was depressed.
“I did this very successfully for months, until – inevitably – it crashed down. One more frantic on-call day was the tipping point. I resigned and got ready to walk away from my career in medicine. I was 34 years old.
“With the help of friends, family and my GP I got better. I started to value my own health and wellbeing. I can’t be the best doctor if I don’t look after myself. The more I talk about it, the more colleagues I find feeling like I did. This isn’t safe, and it isn’t fair on anyone.
“I’m a GP. I have a mental health problem. But I’m a better doctor for accepting that.”
Highland Marketing blog
This week Rob Benson ponders the questions raised by the Wachter Review.
